Complementary Therapies in Medicine - Articles in Press

Prevalence and use of herbal products in the Czech Republic: Over-the-counter survey among adult pharmacies clients - Corrected Proof

Karel Knotek, Vladimir Verner, Petra Chaloupkova, Ladislav Kokoska — 2012-02-10

Summary: Objectives: To analyse which species of herbs are preferred by Czech adult respondents, the most important predictors influencing their use, and information sources used.Method: Data were collected face-to-face via an interviewer-administrated structured questionnaire from convenience sample of adults from metropolis, as well as peri-urban and rural areas, from February to June 2007.Results: There is a high prevalence (56.6%) of herbal product (HPs) use as well as herb-drug co-medication without frequent physician consultation. Literature is the main source of herbal product information, followed by mass media (20%) and family tradition (12%). In comparison to other countries, differences in urban–rural perspectives were observed regarding information sources as well as preferences of local herb species. Mentha×piperita (18.4%), Melissa officinalis (12.4%), Plantago lanceolata (12.2%), Tilia cordata (11.8%) and Matricaria recutita (10.7%) are the most preferred herb species for herbal products preparation. Gender, educational status and age are significant factors that influence the number of herb species used. Head or chest colds, stomach or intestinal illnesses and immunity and regeneration support are the most common ailments treated by herbal products according to our respondents.Conclusion: High utilisation of herbal products was confirmed and the most important predictors of use were identified. Further research is needed to validate and/or replicate our results. Our survey may provide a basis for pharmacists, physicians, healthcare providers as well as for policy makers to effectively manage increasing prevalence of herbal products among the Czech population.

Acupuncturist perceptions of serving as a clinical trial practitioner - Corrected Proof

M.E. Thompson, J. Jenkins, A. Smucker, S. Smithwick, D. Groopman, L.M. Pastore — 2012-02-10

Summary: Objective: This article describes the experience of four acupuncturists in terms of what it meant for them to be a practitioner in a recently completed sham-controlled acupuncture randomized control trial (RCT) with a standardized protocol.Design: At the completion of the RCT for women with ovarian dysfunction, study acupuncturists (2 male MD/acupuncturists and 2 female professional acupuncturists) were queried about their perceptions of participating in the RCT using both written responses to 5 open-ended questions and a focus group interview. Data was analyzed to categorize responses and identify themes.Setting: Virginia, USA.Results: The acupuncturists’ experience of participating in a RCT was generally very positive, including: usual practitioner/participant relationships, collegial sharing, and increased patient volume and diversity. There was angst expressed about the unknown RCT results. While there were concerns about standardizing the acupuncture session (“dilutes the power of acupuncture therapeutics”), the acupuncturists’ were supportive of the pre-established protocol. The acupuncturists overall did not have concerns with a sham intervention arm because the sham recipients did not know their treatment arm and felt as satisfied with study participation as the true acupuncture recipients.Conclusions: Despite initial misgivings about both a standardized protocol and a sham arm, all practitioners discovered positive aspects of being a study acupuncturist. The analysis highlights the need for communication before, during and after a clinical trial between the study investigators and the intervention practitioners. As stake holders in the perception of CAM therapies with the public and with conventional medicine practitioners, it would benefit future research on CAM to similarly assess experiences of being a CAM study practitioner in order to enhance provider recruitment and reduce provider drop-out.

Multiple interacting factors corresponding to repetitive use of complementary and alternative medicine - Corrected Proof

2012-02-10

Summary: Objective: To examine the factors correlating with repetitive use of complementary and alternative medicine (CAM).Research design: In 2006, a community-based epidemiological survey was conducted in Taiwan. A total of 2457 participants (1237 men and 1220 women) aged 18 and over participated in the study.Results: From the application of regression tree analysis and the Health Belief Model, we have noticed the following findings. First, demand motive was the most dominant discriminator factor for the repetitive use of CAM. Second-layer discriminators were evaluated on the basis of action benefits and barriers, as well as sources of action information. Another predominant factor is the heterogeneity of individual background. When participants used CAM for treatment of illness, their household income was ≥1000 US dollars per month, they had past experience of western medicine seeking without effects and aged between 30 and 60 years, the predicted mean values for all types of CAM use is 5.62 (the highest). By contrast, when participants used CAM for maintenance of health, their household income was <2000 US dollars per month, they are male, with moderate or good self-rated health who had less than 9 education years, the predicted mean values for all types of CAM use is 1.36 (the lowest).Conclusion: Upon the above components, it assists us to understand the multiple interactive reasons on people's repetitive use of CAM. It also provides essential information for specific CAM issues. Furthermore, from the different perspectives; it stimulates the thoughts for the future medical care projects.

Use of complementary and alternative medicine by children in Europe: Published data and expert perspectives - Corrected Proof

2012-02-06

Summary: Introduction: Few data document the use of complementary and alternative medicine (CAM) in Europe, with even fewer investigating use by children.Methods: A narrative, non-systematic review of CAM use in Europe was performed by combining data from published surveys with expert perspectives. Limitations created by a lack of representative studies, varying definitions of CAM use, and what qualifies as CAM in different countries was partially overcome by integrating local experts to summarise information available only in the national language and provide their perspectives about CAM availability, quality, use and popularity in their countries using a semi-structured questionnaire. Local and international published surveys were summarised, and the prevalence of CAM use was extrapolated.Results: Data from 20 European countries were available, representing 69% of the European population. Some data about CAM use by the general population were available for 90% of the examined countries, whereas peer-reviewed published surveys were available for only 60%. We extrapolated that 56% (range: 10–90%, adjusted for population size) of the European population in general had used CAM at least once in the past year. Surveys in CAM use by children were available for 55% of the investigated countries. The extrapolated prevalence of CAM use by children in Europe was 52% (range: 5–90%, adjusted for population size). Paediatric CAM experts reported an increasing awareness for and use of CAM in healthcare institutions.Conclusion: This precursor for further surveys indicates that CAM appears to be popular not only among adults in Europe, but also for children. Development of a pan-European definition of CAM use and CAM therapies are required to achieve surveys comparable between European countries. Additionally, more research investigating the efficacy and potential adverse effects of CAM therapies is needed because of increasing CAM use by children in Europe.

Dietary selenium and major depression: a nested case-control study - Corrected Proof

2012-02-01

Summary: Objectives and methods: Alterations in redox biology are established in depression; however, there are no prospective epidemiological data on redox-active selenium in depression. We aimed to determine if low levels of dietary selenium are associated with an increased risk for de novo major depressive disorder (MDD). In this nested case-control study, women aged 20 years or more were identified from a randomly selected cohort being followed prospectively for the Geelong Osteoporosis Study. Cases were individuals with incident MDD, identified using the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP); controls had no such history. Dietary selenium intake was measured using a food frequency questionnaire at baseline, together with anthropometric and lifestyle measures.Results: Eighteen women who developed de novo MDD were classified as cases; there were 298 controls. Low dietary selenium intakes increased the likelihood of developing MDD; OR 2.74 (95%CI 0.95–7.89). After adjusting for age and SES, compared with a high selenium intake, a low intake (<8.9μg/MJ/day) was associated with an approximate trebling of the likelihood for developing de novo MDD; OR 2.95 (95%CI 1.00–8.72). Smoking, alcohol consumption and physical activity did not confound the association.Conclusion: These data suggest that lower dietary selenium intakes are associated with an increased risk of subsequent de novo MDD. We propose that selenium's function as an antioxidant, and as a constituent of selenoproteins that are important in redox homeostasis, warrants further investigation as a risk factor for depression, and suggest a potentially novel modifiable factor in the primary prevention and management of depression.

A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: An RCT - Corrected Proof

P. Tekur, R. Nagarathna, S. Chametcha, Alex Hankey, H.R. Nagendra — 2012-01-27

Summary: Introduction: Previously, outpatient Yoga programs for patients with chronic low back pain (CLBP) lasting several months have been found to reduce pain, analgesic requirement and disability, and improve spinal mobility. This study evaluated changes in pain, anxiety, depression and spinal mobility for CLBP patients on short-term, residential Yoga and physical exercise programs, including comprehensive yoga lifestyle modifications.Methods: A seven day randomized control single blind active study in an residential Holistic Health Centre in Bangalore, India, assigned 80 patients (37 female, 43 male) with CLBP to yoga and physical exercise groups. The Yoga program consisted of specific asanas and pranayamas for back pain, meditation, yogic counselling, and lectures on yoga philosophy. The control group program included physical therapy exercises for back pain, and matching counselling and education sessions.Results: Group×time interactions (p<0.05) and between group differences (p<0.05) were significant in all variables. Both groups’ scores on the numerical rating scale for pain reduced significantly, 49% in Yoga (p<0.001, ES=1.62), 17.5% in controls (p=0.005, ES=0.67). State anxiety (STAI) reduced 20.4% (p<0.001, ES=0.72) and trait anxiety 16% (p<0.001, ES=1.09) in the yoga group. Depression (BDI) decreased in both groups, 47% in yoga (p<0.001, ES=0.96,) and 19.9% in controls (p<0.001, ES=0.59). Spinal mobility (‘Sit and Reach’ instrument) improved in both groups, 50%, in yoga (p<0.001, ES=2.99) and 34.6% in controls (p<0.001, ES=0.81).Conclusion: Seven days intensive residential Yoga program reduces pain, anxiety, and depression, and improves spinal mobility in patients with CLBP more effectively than physiotherapy exercises.

Effect of collagen hydrolysate in articular pain: A 6-month randomized, double-blind, placebo controlled study - Corrected Proof

2012-01-20

Summary: Objective: Evaluation of the efficacy and safety of a food supplement made of collagen hydrolysate 1200mg/day versus placebo during 6 months, in subjects with joint pain at the lower or upper limbs or at the lumbar spine.Design: Comparative double-blind randomized multicenter study in parallel groups.Setting: 200 patients of both genders of at least 50 years old with joint pain assessed as ≥30mm on a visual analogical scale (VAS).Intervention: Collagen hydrolysate 1200mg/day or placebo during 6 months.Main outcome measure: Comparison of the percentage of clinical responder between the active collagen hydrolysate group and the placebo group after 6 months of study. A responder subject was defined as a subject experiencing a clinically significant improvement (i.e. by 20% or more) in the most painful joint using the VAS score. All analyses were performed using an intent-to-treat procedure.Results: At 6 months, the proportion of clinical responders to the treatment, according to VAS scores, was significantly higher in the collagen hydrolysate (CH) group 51.6%, compared to the placebo group 36.5% (p<0.05). However, there was no significant difference between groups at 3 months (44.1% vs. 39.6%, p=0.53). No significant difference in terms of security and tolerability was observed between the two groups.Conclusions: This study suggests that collagen hydrolysate 1200mg/day could increase the number of clinical responders (i.e. improvement of at least 20% on the VAS) compared to placebo. More studies are needed to confirm the clinical interest of this food supplement.

Could ginseng-based medicines be better than nitrates in treating ischemic heart disease? A systematic review and meta-analysis of randomized controlled trials - Corrected Proof

Yongliang Jia, Shikai Zhang, Fangyi Huang, Siu-wai Leung — 2012-01-09

Summary: Background: Ginseng-based medicines and nitrates are commonly used in treating ischemic heart disease (IHD) angina pectoris in China. Hundreds of randomized controlled trials (RCTs) reported in Chinese language claimed that ginseng-based medicines can relieve the symptoms of IHD. This study provides the first PRISMA-compliant systematic review with sensitivity and subgroup analyses to evaluate the RCTs comparing the efficacies of ginseng-based medicines and nitrates in treating ischemic heart disease, particularly angina pectoris.Methods: Past RCTs published up to 2010 on ginseng versus nitrates in treating IHD for 14 or more days were retrieved from major English and Chinese databases, including PubMed, Science Direct, Cochrane Library, WangFang Data, and Chinese National Knowledge Infrastructure. The qualities of included RCTs were assessed with Jadad scale, a refined Jadad scale called M scale, CONSORT 2010 checklist, and Cochrane risk of bias tool. Meta-analysis was performed on the primary outcomes including the improvement of symptoms and electrocardiography (ECG). Subgroup analysis, sensitivity analysis, and meta-regression were performed to evaluate the effects of study characteristics of RCTs, including quality, follow-up periods, and efficacy definitions on the overall effect size of ginseng.Results: Eighteen RCTs with 1549 participants were included. Overall odds ratios for comparing ginseng-based medicines with nitrates were 3.00 (95% CI: 2.27–3.96) in symptom improvement (n=18) and 1.61 (95% CI: 1.20–2.15) in ECG improvement (n=10). Subgroup analysis, sensitivity analysis, and meta-regression found no significant difference in overall effects among all study characteristics, indicating that the overall effects were stable.Conclusion: The meta-analysis of 18 eligible RCTs demonstrates moderate evidence that ginseng is more effective than nitrates for treating angina pectoris. However, further RCTs for higher quality, longer follow-up periods, lager sample size, multi-center/country, and are still required to verify the efficacy.

Acupuncture for symptoms of Gaucher disease - Corrected Proof

Noah Samuels, Deborah Elstein, Ehud Lebel, Ari Zimran, Menachem Oberbaum — 2012-01-09

Summary: Objective: The purpose of this study was to examine the effect of acupuncture on bone/joint pain, headache and fatigue, as well as quality of life in patients with Gaucher disease (GD), within the framework of an integrated treatment programme.Methods: Patients with GD suffering from any of the above symptoms were offered a series of 10–12 weekly acupuncture treatment sessions. Prior to initiation of treatment, participants were asked to score the severity of pain, as well as to complete the Functional Assessment of Chronic Illness Therapy-Fatigue measure (FACIT-F) and the Medical Outcomes Study (MOS) Short-Form (SF) questionnaire. These tools were evaluated again at the end of the treatment period.Results: A total of 12 patients were evaluated. While the only pain outcome reduced by acupuncture was knee pain, a significant improvement was observed with respect to nearly all FACIT-Fatigue measures, including the Physical Well Being (PWB) subscales and the SF-12 Physical Composite Score (PCS), though not for the Mental Composite Score (MCS). Patients reported satisfaction with the treatment process, and no significant side effects were reported.Conclusion: Acupuncture may play a beneficial role for patients with GD when used in conjunction with conventional therapy, reducing fatigue and improving physical function. The preliminary finding of this observational study should encourage further research.

Efficacy of acupressure for non-pharmacological stress reduction in college students - Corrected Proof

2012-01-06

Summary: Objectives: Identifying a non-pharmacological intervention to reduce the stress response could be particularly beneficial to college students, a group prone to considerable stress. Acupressure has shown some efficacy in reducing stress in adults following stroke or traumatic brain injury (TBI), but multiple treatments were required. Results from single treatments in healthy populations have been mixed.Design: The current study used a randomised, placebo-controlled, single-blind design to investigate the use of a single acupressure treatment for stress reduction in healthy college students (n=109) during a stressor.Interventions: Participants were randomly assigned to one of three single, 40-min interventions: active acupressure, placebo acupressure, or a relaxation CD control. A math task stressor administered before and after the intervention assessed intervention effects on stressor responsivity.Main outcome measures: Stress responses were measured by physiological (heart rate (HR), heart rate variability (HRV), skin conductance response (SCR)) and subjective measures (State Anxiety Inventory, nine-item Psychological Stress Measure) of anxiety and stress.Results: All interventions were associated with the following changes during the post-intervention stressor compared to the pre-intervention stressor: reduced HR (p<0.001), increased HRV (p<0.024), reduced SCR (p<0.001), reduced subjective stress scores (p<0.001), and increased correct answers (p<0.001). Although all groups demonstrated stress reduction, there were no significant group differences after a single treatment.Conclusions: All interventions significantly reduced the stress response, although not differently. The lack of active acupressure-associated treatment effects appears to be due to insufficient dosing.

Clinical efficacy and safety of Chinese herbal medicine for Wilson's disease: A systematic review of 9 randomized controlled trials - Corrected Proof

2012-01-06

Summary: Wilson's disease is an autosomal recessive disorder of copper metabolism. Despite being treatable, there is no universally accepted treatment regimen. Currently, various Chinese herbal medicines (CHMs) are widely used in the treatment of Wilson's disease in China, but there is a lack of reliable scientific evidence for the effectiveness of such therapies. The objective of this systematic review is to assess the clinical efficacy and safety of CHM as an alternative or/and adjuvant therapy for Wilson's disease. A systematic literature search in different medical databases was performed to identify randomized controlled trials comparing CHM as monotherapy or CHM as adjuvant therapy with western conventional medical therapy in the treatment of Wilson's disease. A total of 687 participants were included in nine eligible studies. The main findings are that CHM as monotherapy or adjuvant therapy for Wilson's disease may be able to improve the clinical symptoms, to promote the urinary copper excretion, to ameliorate liver function and/or liver cirrhosis, and has fewer adverse effects in comparison with western conventional medication. Furthermore, CHM generally appeared to be safe and well tolerated in patients with Wilson's disease. However, the evidence presented in this review are insufficient to warrant a clinical recommendation due to the generally low methodological quality of the included studies. In conclusion, CHM seems to be beneficial and safe for Wilson's disease, but high-quality evidences are still needed to further evaluate this therapy. Therefore, additional well-designed, randomized, placebo-controlled clinical trials are needed.

Spinal manipulations for tension-type headaches: A systematic review of randomized controlled trials - Corrected Proof

P. Posadzki, E. Ernst — 2012-01-03

Summary: Aims: The objective of this systematic review was to assess the effectiveness of spinal manipulations as treatment option for tension type headaches.Methods: Eight databases were searched from their inception to May 2011. All randomized trials were considered, if they investigated spinal manipulations performed by any type of healthcare professional for treating tension type headaches in human subjects. The selection of studies, data extraction, and validation were performed independently by two reviewers. The Cochrane tool and the Jadad score were used to assess methodological quality of trials.Results: Five randomized clinical trials (RCTs) met the inclusion criteria. Their methodological quality was mostly high and ranged between 2 and 4 on the Jadad score. Four RCTs suggested that spinal manipulations are more effective than drug therapy, spinal manipulation plus placebo, sham spinal manipulation plus amitriptyline or sham spinal manipulation plus placebo, usual care or no intervention. One RCT showed no difference in daily hours of headache, pain intensity, and daily analgesic use compared to soft tissue therapy plus placebo laser.Conclusions: The evidence that spinal manipulation alleviates tension type headaches is encouraging, but inconclusive. The low quantity of the available data prevent firm conclusion.

Surveys of complementary and alternative medicine usage: A scoping study of the paediatric literature - Corrected Proof

Soleil Surette, Leah Vanderjagt, Sunita Vohra — 2011-09-23

Summary: Objective: To conduct a scoping review of paediatric CAM utilisation literature, in order to establish the depth and breadth of the field and identify gaps in knowledge regarding the epidemiology of CAM use.Methods: A CAM and paediatric search strategy was developed and run in three databases (Medline, Embase, Amed) in June 2006. It was revised and rerun in February 2010. Utilisation studies about paediatric CAM were selected if they had an English or French abstract. Data were extracted into an excel table by one individual.Results: 152 paediatric CAM utilisation studies were identified as of February 2010, 136 were fulltext English. There was variation in how CAM was defined: vitamins were included in 35 studies, excluded in 12 studies and not mentioned in 40; while prayer was included in 64, excluded in 9, and not mentioned in 39. Over half of the studies identified were from North America. The majority of studies were conducted in conventional health settings. The four most commonly studied subpopulations were cancer, asthma, autistic spectrum disorder, and attention deficit hyperactivity disorder. Eighteen percent of studies did not report on the period of assessment used. Twenty-seven percent of studies inquired about adverse events and 32% inquired about costs and insurance coverage.Conclusion: There are substantial paediatric utilisation data available but some subpopulations remain poorly researched. The need for transparent utilisation data remains important in order to help prioritize safety and efficacy research.

Perspective on fever: The basic science and conventional medicine - Corrected Proof

Joseph G. Cannon — 2011-09-19

Summary: This review describes how fever is generated as a regulated increase in body temperature. It results from an upward shift in the thermoregulatory set point, mediated by pyrogenic cytokines released from monocytes/macrophages in response to infection or trauma. Evidence will be presented that fever is part of an integrated host defense system, and that failure to generate a fever in response to infection is generally associated with a poorer prognosis.

Use of complementary and alternative medicine in healthy children and children with chronic medical conditions in Germany - Corrected Proof

2011-07-11

Summary: Objectives: Use of complementary and alternative medicine (CAM) in children is common and probably increasing. However little is known about differences between healthy and chronically ill children with a focus on prevalence, reasons for use/non-use, costs, adverse effects and socio-demographic factors.Design: A questionnaire-based survey with 500 participants visiting the outpatient clinic of the University Children's Hospital Homburg, Germany was conducted over a 4-week period in 2004. Recruitment was stopped when 500 questionnaires were handed out in total.Results: Of the 405 (81%) respondents (242 with chronic conditions, 163 healthy children incidentally visiting the hospital for minor ailments) 229 (57%) reported lifetime CAM use (59% with chronic conditions versus 53% healthy children). Among CAM users the most prevalent therapies were homeopathy (25%), herbal remedies (8%), anthroposophic medicine (7%), vitamin preparations (6%) and acupuncture (5%). The main reasons for use were to strengthen the immune system, physical stabilisation and to increase healing chances/maintain health. Socio-demographic factors associated with CAM use were tertiary education (mother: p=0.017; father: p>0.001), higher family income (p=0.001) and being Protestant (p=0.01). Expectations towards CAM were high and most parents would recommend certain CAM (94%). 79% of the users informed a physician about CAM use. Side effects were rarely reported (4%), minor and self-limiting.Conclusions: Clinical care and the physician-patient relation would benefit from an enhanced understanding of CAM and a greater candidness towards the parental needs. The safety and efficacy especially of CAM with high prevalence rates should be determined in rigorous basic and clinical researches.

The PedCAM Network: Past, present, and future - Corrected Proof

Soleil Surette, Sunita Vohra — 2011-04-21

Summary: Established in 2004, the Pediatric Complementary and Alternative Medicine Research & Education (PedCAM) Network (www.pedcam.ca) is a multidisciplinary national and international network focused on pediatric research and education with the vision of safe and effective use of complementary and alternative medicine (CAM) use in children and youth and is designed to be a networking and information resource for both researchers and practitioners in the field of pediatric CAM. PedCAM offers a wide variety of resources and opportunities to researchers, clinicians, educators and the general public: educational, and funding opportunities; links to core articles and books; a searchable database of pediatric CAM research articles; biweekly electronic updates for members. Currently, it is engaged in several research projects to strengthen the pediatric CAM knowledge base: (i) a modified Delphi consensus process for establishing a pediatric CAM research agenda; (ii) the identification of validated pediatric outcome measures; and (iii) a synthesis of pediatric CAM utilization studies to identify knowledge gaps. The widespread use of CAM in children, and the resulting need for high quality research and education, suggests that the PedCAM Network will remain relevant and timely in its efforts to connect those working in the field of pediatric CAM in Canada and around the world.